Identifying new graduate nurses’ comfort with and perception of expressive touch: a mixed methods study
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Background: Nurses use physical touch to interact with patients and address their needs. Human touch benefits social development, stress/anxiety reduction, and rapport building. Some types of touch, such as expressive touch (or the touch used to convey compassion, such as hand holding) can benefit both the patient and caregiver. However, nurses have been shown to be less comfortable with expressive touch as compared to other forms of touch. Inversely, unconsented touch could cause distress to patients. In either case, touch in any form other than procedural is not currently a part of standardized nursing education, despite the numerous studies that indicate a need for such education. New Graduate Nurse (NGN) orientation programs also lack education regarding expressive touch. Before expressive touch education can be developed, baseline information, such as NGN comfort with and perceptions of touch, must be described. Objective: The purpose of this mixed methods study incorporating a quantitative cross-sectional, descriptive, correlational strand and a qualitative descriptive strand, was to 1) ascertain the NGN comfort level with expressive touch, 2) study the correlations between that comfort level and other demographic data such as ethnicity and years of experience, and 3) describe and explore the “who, what, and where” of experiences from the perspective of individual NGNs. Method: A convergent mixed-methods design was used. Instrument: The Nurses’ Comfort with Touch Scale (a validated quantitative survey tool) and a qualitative interview guide were used for this study. Procedure: A cross-sectional online survey, offering the option to self-enroll in the qualitative strand of the study, was administered during a hospital’s already established NGN onboarding programs. Data were analyzed using statistical software with the assistance of a biostatistician. Results: A total of 108 NGNs participated in the quantitative strand of this mixed methods study. The quantitative sample was 77.8% female, with an average age of 29. Overall, NGNs were between neutral and slightly comfortable with expressive touch. NGNs were most comfortable with holding the hand of a patient experiencing anxiety and least comfortable with letting a patient rest their head on the nurses’ shoulder. No correlation was found between NGN age, months of experience as an NGN, and years of experience at the bedside to NGN comfort with expressive touch. Sex assigned at birth (male) was the only demographic variable to have a predictive relationship with NGN comfort with expressive touch (p=<.001, d=0.945). In the qualitative strand, 12 NGNs participated and six patterns were identified: 1) comfort/presence, 2) anxiety reduction, 3) connection, 4) knowing how, when, and who to touch, 5) a natural part of meeting patient needs, and 6) healing. Discussion: NGN comfort level with expressive touch was slightly lower, though comparable, to other studies that measured nurse comfort with expressive touch. Qualitative findings are congruent with other qualitative studies regarding nurses and expressive touch, though new information such as the perception of expressive touch as healing was discovered. Conclusion: This study provided new ways of understanding the depth of expressive touch and its meaning to NGNs. NGNs perceived expressive touch is an important part of caring for their patients. Discrepancies between the importance of expressive touch to the discipline of nursing and NGN comfort with expressive touch indicate the need for interventions regarding the appropriate use of expressive touch. The findings have implications for theory, practice, and research.
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Introduction -- Review of literature -- Methodology -- Results -- Discussion
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Ph.D. (Doctor of Philosophy)